Southside Community Health Services, Inc.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.

Practice address

4243 4TH Ave S
Minneapolis, MN 55409-2113

Phone

(612) 822-9030

Fax

(612) 821-2818

NPI assigned

Mar 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ann Cazaban

Title

Executive Director

Phone

(612) 821-2025

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southside Dental Clinic Other name

Tax ID family

Southside Community Health Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Southside Community Health Services, Inc.

  • Community/Retail Pharmacy
  • Minneapolis, MN
  • NPI 1356257083
  NPD tax ID
• Southside Community Health Services, Inc.

  • Dentist
  • Minneapolis, MN
  • NPI 1376409276
  NPD tax ID
• Southside Medical Clinic at the Adler Center

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1700121084
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1992822290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4243 4TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092113",
            "telephone_number": "612-822-9030",
            "fax_number": "612-821-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4243 4TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092113",
            "telephone_number": "612-822-9030",
            "fax_number": "612-821-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "CAZABAN",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-821-2025"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "635323100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Southside Chiropractic, P.a.
• Southside Community Health Services, Inc.
• Southside Community Health Services, Inc.
• Southside Community Health Services, Inc.
• Southside Community Health Services, Inc.
• Southside Family Charter School
• Southside Life Care Center
• Southside Medical Clinic at the Adler Center
• Southside Midwifery Collective Inc
• Southside Transportation LLC

• Dentist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.